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JAMA Clinical Challenge

Lower Extremity Purpura

Image of Lower Extremity Purpura

Huan J. Chang, MD, MPH
A 50-year-old woman comes to your office for evaluation of a vasculitic-appearing cutaneous eruption of unknown duration on the lower extremities. Her medical history includes heavy smoking with subsequent chronic obstructive pulmonary disease (COPD). Findings from a general physical examination show her to be a cachectic woman who appears older than her stated age. Cutaneous examination reveals a perifollicular, hyperkeratotic purpuric eruption on her lower extremities. Pertinent laboratory values showed megaloblastic anemia, low serum folate levels, and a mild elevation of liver function test results.

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Author Affiliation: Dr Chang (tina.chang{at}jama-archives.org) is Contributing Editor, JAMA.